Page last updated at 10:47 GMT, Wednesday, 17 March 2010

Concerns over increase in rickets among ethnic groups

By Divya Talwar
BBC Asian Network

Coloured X-Ray of the legs of a child with rickets
Coloured X-Ray of the legs of a child with rickets

Doctors are warning of a continuing rise in rickets with hundreds of children developing the condition every year.

The crippling bone disease is caused by a lack of vitamin D and can lead to deformities like bowed legs as well stunted growth and general ill-health.

The disorder was prevalent in Victorian times but in recent years it has made a comeback and experts say it is a growing problem, particularly in Asian and Afro-Caribbean children.

More than 200 children a year are being treated for rickets at the Leicester Royal Infirmary.

Worrying trend

Dr James Greening, an expert in rickets based at the hospital, said this figure was probably much higher.

"Only the very extreme cases of rickets in the area are referred to me as most of the cases are seen by local GPs and paediatricians,'' he said.

Dr Sudhir Sethi, a consultant paediatrician based in Leicester, said that while there were no national statistics, he estimated there were hundreds of new cases being diagnosed each year across the country.

It's very frustrating because the disorder is entirely preventable
Dr Sudhir Sethi
Consultant paediatrician

''There is a great deal of anecdotal evidence to suggest that this is a growing problem, especially within the Asian and ethnic minority communities," he explained.

''I am really shocked and saddened by the worrying trend we are seeing.

''We thought that this was a disease that had been eradicated but now I frequently see small children walking into my office with bowed legs and sometimes older children coming to me to complain of severe aches and pains.

"It's very frustrating because the disorder is entirely preventable.''

A lack of vitamin D can be caused by poor diets and insufficient exposure to sunlight, which helps the body synthesise the vitamin.

Although white children are also being diagnosed with rickets, those from Asian and Afro-Caribbean backgrounds are at greater risk because their darker skin means they do not absorb as much sunlight.

Children from some communities need to wear particular clothing for cultural reasons and this may also limit their exposure to the sun.

The Department of Health issued advice about rickets two years ago, but the anecdotal evidence suggests the problem is not getting any better.

Lasting effect

Rommi Rifibakhit was diagnosed with rickets when he was two years old.

Rommi Rifibakhit and his father Osman
Rommi Rifibakhit was diagnosed with rickets at two years old

His parents, from Slough, realised that something was wrong when they saw the physical signs of the disorder.

His father Osman said: "He hadn't started walking or even crawling. He wasn't very active and he would just sit very quietly in one place.

"We also noticed that his wrists had started widening and eventually we took him to the doctors.

''We were shocked and really worried when we found out that he had rickets - we didn't even know what it was.''

Two weeks after Rommi began his treatment, he started walking and his parents say he is now a normal toddler who runs around the house with bags of energy.

Although rickets is curable with adequate vitamin supplements and exposure to sunlight, doctors warn it can have long-lasting physical and psychological effects on the child and parents.

"Even once the child has been diagnosed, it can take a good few years for the legs to straighten,'' said Dr Sethi.

"This can have a significant impact on the early years of a child's life.

''There was a little boy that came to my clinic with bow legs and his mother told me that she had stopped taking him to any public gatherings.

Dr Minoo Irani, a paediatrician specialising in rickets
Dr Irani is concerned for pregnant women when it comes to rickets

"And, whenever she took him out she would dress him in very loose clothing so no-one could see his legs.

"This is very sad that parents often feel ashamed that their child has developed the disorder and try to hide it.''

The Department of Health is urging all pregnant and breastfeeding women to take a daily vitamin D supplement to ensure their babies get enough of it.

Free vitamins are available through the government's Healthy Start initiative.

The scheme supports families on low incomes by providing coupons that can be exchanged for women's and children's vitamins as well as vouchers that can be used to buy fresh fruit, vegetables and milk.

Taking an appropriate supplement during pregnancy and when breastfeeding will increase the vitamin D stores of both the mother and her baby to reduce the child's risk of developing rickets.

Dr Minoo Irani, a paediatrician specialising in rickets, has advised pregnant women from ethnic minority backgrounds in particular to be screened in order to detect vitamin D deficiencies.

"If women have low levels of vitamin D then their baby can also be born with a deficiency which can put it at risk of developing rickets," he said.

"All women from a high-risk background, who are thinking of getting pregnant, should be tested and, if they are found to be deficient, then they can be adequately treated."

You can hear more on this story at 1230 and 1800 GMT on 17 March on the BBC's Asian Network Reports radio show or via the BBC iPlayer.



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